Branham v. Gardner

• Decision Date: 08 September 1967
• Docket Number: No. 16911.,16911.
• Citation: 383 F.2d 614
• Parties: John B. BRANHAM, Plaintiff-Appellant, v. John W. GARDNER, Secretary of Health, Education and Welfare, Defendant-Appellee.
• Court: U.S. Court of Appeals — Sixth Circuit

383 F.2d 614 (1967)

John B. BRANHAM, Plaintiff-Appellant, v. John W. GARDNER, Secretary of Health, Education and Welfare, Defendant-Appellee.

No. 16911.

United States Court of Appeals Sixth Circuit.

September 8, 1967.

COPYRIGHT MATERIAL OMITTED

Ronald W. May, Pikeville, Ky., for appellant.

Moss Noble, Asst. U. S. Atty., Lexington, Ky., George I. Cline, U. S. Atty., Lexington, Ky., on brief, for appellee.

Before McCREE, Circuit Judge, PORTER,^* District Judge, and McALLISTER, Senior Circuit Judge.

McALLISTER, Senior Circuit Judge.

This appeal is from denial of an application for disability benefits under the Social Security Act. The Hearing Examiner's decision was approved by the Appeals Council, and thereafter the District Court dismissed the claim.

Appellant is a man past sixty years of age. He "got nowhere in school," never learned to read or write, and became a manual laborer when he was twelve years old, helping his father cut mine timbers. He continued at this work until he was fourteen, when he got a job working on a coke oven as a dauber, and continued this job for two years until he was sixteen years old, when he started work as an underground coal miner. He then worked for thirty-six years as a hand loader in the coal mines. In August 1959, he became so ill while at work as a coal miner that he had to quit the job.

First of all, in order to understand what this controversy is about, it will clarify the case to state that appellant's claim is that he is disabled as a result of psychoneurosis, anxiety reaction, coupled with accompanying cardiac and arteriosclerotic impairments.

Psychoneurosis is a term used in psychiatry. While those who believe in a so-called "no-nonsense" approach to mental illness say that, in common parlance, everyone is neurotic, there are none skilled in the science of psychiatry or medicine who would disagree with regard to the meaning of psychoneurosis, as that term is used by physicians and psychiatrists.

It might be well here to recall that in the case of Pollard v. United States, 282 F.2d 450 (C.A.6), this court had occasion to recognize the debt which society owes to psychiatry, when we said, with respect to the controlling issue therein considered:

"Psychiatry is a great and important science upon which the legislative and judicial branches rely. Federal statutes provide for psychiatric examinations of persons accused of crime, as well as those deemed to be suffering from mental illness or insanity. Courts consider evidence from psychiatric experts in arriving at a determination whether an accused is not guilty of crime by reason of insanity."

In the above cited criminal case, this court held that the undisputed evidence of psychiatric experts that the defendant therein was not responsible for his actions because of psychoneurosis, dissociation reaction, could not be disregarded by the court, but must be accepted as against the "common sense" view of the trial judge that defendant was so responsible.

We are speaking, then, in this case of psychoneurosis and anxiety reactions, not as lawyers or laymen but, necessarily, according to the evidence presented, of those terms, as used by experts — psychiatrists and physicians — who have embodied them in their psychiatric and medical reports which were considered in the evidence on the hearing of this case.

As this court said in Miracle v. Celebrezze, 351 F.2d 361, 376:

"Studies in psychosomatic medicine, as hereafter appears, disclose that emotions can cause transitory or chronic disturbances of physiological functions, and this fact is sustained by the courts. In this case, Dr. Beeman, after examining appellant, recommended that he should have the benefit of consultation with a neurologist and, perhaps, a psychiatrist because of the degree of anxiety present. Dr. Baird stated that appellant was extremely psychosomatic. Other physicians gave it as their opinion that there was a large psychosomatic element affecting appellant\'s condition. In `Mental Abnormality and Crime\' published as one of the English Studies in Criminal Science, by the Department of Criminal Science, Faculty of Law, University of Cambridge (MacMillan and Co., Ltd., London, 1944), Dr. D. R. MacCalman, M.D., Lecturer in Psychopathology at Aberdeen University, at p. 129, states:

"`We must first distinguish from the normal anxiety which the average workman feels after injury and an anxiety neurosis proper. Anxiety of the normal type is bound to occur in a disabled workman, for his most precious possession, his health, has been threatened, perhaps permanently, and this constitutes, to himself and his family, a threat which is very real. The reduction in pay from his normal wage to thirty shillings weekly, which is the maximum disablement allowance made under the Act, means using up his savings or semi-starvation for his household. Even this meagre allowance may be further reduced when he is certified fit for "light work". He tries to get work, but who will employ him in his disabled or semi-disabled condition? He becomes tense, irritable, sleepless, or, if he loses hope, listless, soured and indifferent. Such a state is unfortunately only too common; it is painful and serious, but it is not an anxiety neurosis. It is caused by an obvious and very real environmental threat to security; it would never occur if injured workmen were relieved of material anxiety, if they got proper rehabilitation treatment and were assured of employment in the future.

"`Now, because this normal type of anxiety can be relieved by suitable work and economic security, a regrettable fallacy has crept into the attitude of doctors and lawyers toward neurosis cases. They see that the patient suffers from anxiety, mistake it for normal worry over his position, and think that he will be cured by work. This not only implies that a neurosis is something akin to laziness, or at least faint reluctance "to do an honest day\'s work", but confuses the condition with a consciously determined attitude of mind. Even patients themselves have been fooled into believing that work would cure them. Nothing is further from the truth. A neurosis can be cured only by psychotherapy * * *.\'"

Further, in Miracle v. Celebrezze, supra, p. 376, quoting an authority in psychiatry, it was said:

"`Arthritis, for example, may be the reaction to a simple, emotional disturbance. It may mark a deeply buried emotional disturbance. It may have created such tissue damage that it is called organic. In all three cases the joints may be equally swollen, the pain equally intense.\'"

It used to be that, unless impairment or disabilities could be substantiated by objective symptoms, they were not considered, as, in any way, established. "But modern medicine is neither so scientific nor so helpless today that it either does, or must, evaluate only objective factors." Hayes v. Celebrezze, 311 F.2d 648, 654 (C.A.5).

In Walker v. Gardner, reported July 3, 1967, in 266 F.Supp. 998, 1002 (D.C. Ind.), it was stated:

"It is well established that disability as defined in the Social Security Act may be a result of physical or mental impairments, or a combination of both. `(T)here is no need to consider mental and physical condition separately. We have come too far in our knowledge of the relationship of mind and body totally to truncate one from the other in our considerations. Just as all physical and all mental impairments must be taken into account in determining the extent of disability, so may physical and mental impairments in their totality result in a finding of disability.\' Farley v. Celebrezze, 3 Cir., 1963, 315 F.2d 704. And purely subjective symptoms may sustain a finding of disability. Page v. Celebrezze, 5 Cir., 1963, 311 F.2d 757. For a detailed discussion of the disabling effects of anxiety neurosis, see Miracle v. Celebrezze, 6 Cir., 1965, 351 F.2d 361, beginning at page 375."

Psychoneurosis, with anxiety reaction, is the most important element in this case.

The diagnostic terms employed by psychiatrists and in the records of mental hospitals are abbreviations for sets of symptoms which are relatively standardized in medical literature and increasingly relied upon in practice. That laymen are less familiar with the content of these terms than with the terminology of older branches of medicine, should not cause us to close our eyes to useful evidence. We have gone far since the days when mental injury was considered too speculative to be compensable. Where we are dealing with regularly recorded psychiatric diagnoses, which would be acceptable in testimonial form, there is no reason to condemn them as more conjectural than ordinary medical diagnoses, or as less likely than ordinary medical diagnoses to be agreed upon by equally competent men. Lyles v. United States, 103 U.S. App.D.C. 22, 254 F.2d 725, 740. In the instant case, psychoneurosis is a disorder recognized in the Regulations governing disability benefits under the Social Security Act, 20 C.F.R. Sec. 404.1519.

Psychoneurosis, as defined in "A Psychiatric Glossary" approved by the American Psychiatric Association,¹ consists of: "Emotional maladaptations due to unresolved unconscious conflicts. One of the two major categories of emotional illness, the other being the psychoses. A neurosis is usually less severe than a psychosis, with minimal loss of contact with reality. Thinking and judgment may be impaired. A neurotic illness represents the attempted resolution of unconscious emotional conflicts in a manner that handicaps the effectiveness of a person in living. Types of neuroses are usually classified according to the particular symptoms which predominate. Common types are:

"anxiety reaction: Characterized primarily by direct experiencing of anxiety, which may have an acute or gradual onset, with subjective uneasiness or apprehension out of proportion to any apparent external cause. The anxiety is uncontrollable * * *."

We have seen from the...